MEDICARE: JACKIE COHRS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC005399	FL
2	152W00000X	Optometrist	2018033453	MO
3	152W00000X	Optometrist	3773	MN

General Provider Information

NPI Number	:	1932637774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE COHRS OD

Provider Business Mailing Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-2511
Country	:	US
Telephone Number	:	507-284-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-2227
Country	:	US
Telephone Number	:	507-284-2511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	06/01/2022

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Directions to “ JACKIE COHRS OD” Practice Location

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